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Please help! Second time posting this question...

  1. #41
    Location
    Greeley, Colorado
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    2,045
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    Medical Coding Books
    Quote Originally Posted by Walker22 View Post
    I agree that in 2010 these codes are no longer add-on codes, but the original discussion was about a DOS that occured in 2009, so I was using the 2009 CPT book as my source. Furthermore, I believe that I was as respectful as possible (I even said "I respectfully disagree"), and tried to end the debate before it got out of hand, to no avail.
    You are correct Walker 22, and I should have added that the original question was for 2009. I just wanted to add that 2010 brought about a change in 99358-99359. My comments were not directed at you, but to the post in general as it did get heated. I think it was a difference of interpretation, understanding and opinion (since this covered a lot of ground) between you and Herbie Lorona. I agree the 2010 CPT is not valid until 2010 and was pointing out the change effective for 2010 according to the Insiders View...
    Just wanting the forum to remain a friendly place for all of us
    Lisa Bledsoe, CPC, CPMA

  2. #42
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    All is good :-)
    Walker Bachman, CPC, CPPM

  3. #43
    Location
    Jacksonville, FL River City Chapter
    Posts
    74
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    I don't usually like to post a full CPT Assistant Q and A but I feel here it is warranted. The CPT book clearly states that counseling can be performed with the patient AND/OR family to qualify for an E/M code:

    CPT Assistant
    December 2004 page 19
    Coding Consultation:Questions and Answers
    Evaluation and Management, (Q&A)

    Question
    What is the appropriate code to report for a service in which the physician provides only counseling and/or coordination of care regarding symptoms or an established illness to the family without the patient being present?

    AMA Comment
    From a CPT coding perspective, time may be considered the key or controlling factor when the physician provides counseling and/or coordination of care that dominates (more than 50%) the patient and/or family encounter. For time to be considered a key component, the physician must spend face-to-face time with the patient and/or family (without the patient) in the office or other outpatient setting. This would include time spent with parties who have responsibility for the care of the patient or decision-making regardless of whether they are family members (eg, foster parents, person acting in loco parentis, legal guardians). The key components of history, physical examination, and medical decisionmaking do not need to be provided or documented when counseling and/or coordination of care dominates. Typical times are included in each code descriptor to assist in selecting the most appropriate level of E/M service.

    ________________________________________

    There are many reasons why this could be appropriate, such as a physician's need to gather additional history from the family/caretaker in his/her attempts to refine a patient's diagnosis, to discuss the patient's at-home care that will be performed by the family member/caretaker, and so on. These are usually necessary in cases where the patient is unable to provide meaningful history (due to senility or other) or cannot adequately comprehend or implement instruction given by the physician and so the family member must "step in" and help. If a patient is senile and it is not time for the next physical exam or diagnostic test, there is no medical need to drag them to the office to sit in the next chair while the doctor gives updated care instructions to the family member.

    Medicare goes its own way, and has often said that it still prefers the patient to be present or else use the family counseling time in the next face-to-face E/M code billed. They also say that the MDM component must still be evident in the documentation. But that is Medicare, not CPT, and this is not a Medicare situation.

    Seth Canterbury, CPC, ACS-EM
    Last edited by SCanterbury; 02-16-2010 at 08:56 AM.

  4. #44
    Location
    North Carolina
    Posts
    3,126
    Thumbs up
    How did I miss this thread????

    Walker, way to hang in there!!

    Seth...as always, your expertise is on the mark!

  5. #45
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    Quote Originally Posted by rebeccawoodward View Post
    How did I miss this thread????

    Walker, way to hang in there!!

    Seth...as always, your expertise is on the mark!
    Thanks Rebecca! This is fast becoming my favorite thread... LOL
    Walker Bachman, CPC, CPPM

  6. #46
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    So, I'm in the position to code a visit where the patient is terminal and not present. The family came in to discuss the Drs. plan for the patient. Our Drs. do not have hospital priveleges. I read all 10 pages and I just about have a headache; however, since I am a coder and love my job, I'm trying to see it from both viewpoints. I will respectfully have to agree with Walker22 and I will explain why. I agree with the reasons given for office visit codes and in addition, it doesn't matter to me if Prolonged Physician Service Without Direct (Face-to-Face) Patient Contact (99358) is no longer an add-on code for 2010, the small print says that it is inappropriate for this use. Here it is:

    My CPT book specifically says, "Do not report 99358-99359 for time spent in medical team conferences, on-line medical evaluations, CARE PLAN OVERSIGHT, anticoagulation management, or other non face-to-face services that have more specific codes and no upper time limits in the CPT code set. Codes 99358-99359 may be reported when related to other non face-to-face service codes that have a published maximum time (eg. telephone services).

    Is this discussion re: care plan oversight? It is for me! This seals the deal for me. Office visit 99212-99215 it shall be. I would personally use these prolonged codes if my Dr. told me and documented that s/he spent an hour or more reviewing records pertaining to a visit with the patient after the patient left. I would also use this if my Dr. received a pile of old records from another provider or from archives and the patient was new or established and going to come in at a later date or later that day for a visit.

    My question is: what diagnosis would you use? The patient's illness or V61.49?
    Last edited by hthompson; 02-18-2010 at 02:09 PM. Reason: Additional thought to add...
    Heidi Thompson, CPC

  7. #47
    Location
    Jacksonville, FL River City Chapter
    Posts
    74
    Default
    You would use the patient's diagnosis code AND a V-code. But I wouldn't use the V-code for sickness in the family. This code implies that the service revolves around the presenting family member's issue that they have to deal with all of the problems associated with another family member who is sick.

    You would instead use V-code V65.19 Other person consulting on behalf of another person under the V65.1 category, as this includes "advice or treatment for non-attending third party." Using this code along with the "non-attending" patient's dx code makes it clear to the payer that the patient is not physically present. If the specific payer has a problem with CPT's allowance that a doctor can meet with the family on behalf of the patient, they usually have edits tied to this code. Using it will give them the opportunity to deny it if they have a stricter policy than CPT that defines a face-to-face service as a service between the doctor and patient (not AND/OR family as CPT allows).

    Seth

  8. #48
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    I agree, I figured that out during the last 2 months
    Heidi Thompson, CPC

  9. #49
    Location
    Jacksonville, FL River City Chapter
    Posts
    74
    Default
    Yeah, sorry for the delay. I'm not on these boards very often...

    Seth

  10. #50
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    LOL, not your fault! I just couldn't wait and then I forgot that I asked, so I didn't go back and answer my own question.
    Heidi Thompson, CPC

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